Navegando por Palavras-chave "Megacolo"
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- ItemAcesso aberto (Open Access)Avaliação clínica, manométrica e profilométrica dos pacientes portadores de megacolo congênito submetidos à cirurgia de abaixamento de colo pelas técnicas de Duhamel modificado ou Retossigmoidectomia Transanal(Universidade Federal de São Paulo (UNIFESP), 2007-09-26) Martins, Elaine Cristina Soares [UNIFESP]; Martins, José Luiz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Objective: Several techniques are being proposed for a definite treatment using surgery for the Hirschsprung’s disease or congenital megacolon (CM). This study aims to evaluate the differences in the surgery results obtained with manometric anorectal procedure and profilometric analysis, as well as verify its correlation with clinical parameters of patients’ fecal standard results who were submitted to one of these two techniques for the CM chirurgic treatment: 1.colectomy of the aganglion segment and modified Duhamel procedure (MD) to perform a pull through of the ganglionic colon; and 2. colectomy of the anglion segment and modified transanal rectosigmoidectomy (MTR). Methods: The present study submitted, for the period of April 2001 to March 2006, 42 patients to clinical evaluations and anorectal manometry for a post-operative control for a CM correction procedure, of which 36 were male (74%) and 6 female (26%). All patients were submitted to the exam without sedation, using the perfusion technique, in the post-operative period, seeking to evaluate the resting pressure (RP), the pressure response of the sphincter to cough (C), the pressure response to voluntary contraction (VC), the pressure response to sustained voluntary contraction (SVC), the pressure response to perianal stimulation (PAS), the analysis of the rectal sphincter reflex (RSR) and to analyze the standard and potentiation pressure curves. With the pressures acquired from the pressure curve elaboration in the perfusion channels, a tridimensional image of the anorectal canal was taken, allowing us to study the distribution of the pressure in the anorectal walls. Furthermore, aiming to compare the manometric, profilometric and clinical variables between the two exploited techniques, a Student-t test was applied for the cases in which the variables were continuous. A Chi-squared test was also proposed and, whenever necessary, the Fisher’s exact test; in order to verify the differences in the distribution of a categorized characteristic, as well as to compare the variables between the techniques regarding the fecal continence standard (continent and partially continent), and the significant level criteria adopted was 5%. Results: The ARM demonstrated RP average of 53,44 mmHg for the MD group and 60,67 mmHg for the MTR. Regarding the VC pressure, an average of 94,50 mmHg was attained for the MD group and of 95,47 mmHg for the MTR. There is not a significant difference, statistically, between the MD and MTR groups. It is important to highlight that the average amount of the voluntary contraction pressure was almost double the resting pressure, which is expected, in general, when incontinence research is concerned. It was also noticed, that there was no significant difference, statistically, among the manometric variables, independently of the technique employed, whether in the general group, in the continent group, or, even in the partially continent group. The nonexistence of a significant difference, statistically, for the pressure amount of the internal, external sphincter and ascending colon reinforce the idea that the pull through procedure with the oversewing of the rectum technique, similar to the one proposed by Swenson, do not expose the complex of the sphincter muscles to risks.The absence of RSR was observed in almost all of the analyzed cases, which to the forms CPS and CPP did not show significant difference, statistically, independently of the technique employed. There is also no significant difference, statistically, for the CPS and CPP forms to the continent and partially continent groups, whether in the general group, in the DM group or in the MTR group. Conclusion: With this present study, it was perceived that both operative procedures for pull through procedure of the ganglionic colon, in which case were, the MD technique and MTR technique, are equivalent from the manometric and profilometric standpoint.
- ItemAcesso aberto (Open Access)Clinical, manometric and profilometric evaluation after surgery for Hirschsprung's disease: comparison between the modified Duhamel and the transanal rectosigmoidectomy techniques(Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia, 2009-10-01) Martins, Elaine Cristina Soares [UNIFESP]; Peterlini, Fábio Luis [UNIFESP]; Fagundes, Djalma José [UNIFESP]; Martins, Jose Luiz [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)PURPOSE: To evaluate fecal continence, anorectal manometry (AM) and profilometry (P), in patients operated for congenital megacolon, using either the modified Duhamel technique (MDT) or the modified transanal rectosigmoidectomy (MTR) technique. METHODS: 42 patients were evaluated clinically and via AM and P, for postoperative control. The resting, coughing, voluntary contraction, maintained voluntary contraction and perianal stimulation pressures were investigated. The rectosphincteric reflex was tested and the simple and enhanced pressure curves were evaluated. The three-dimensional profilometric outline was produced. Student's t, chi-squared and Fisher's exact tests were used for statistical analysis (p<0.05). RESULTS: AM showed mean resting pressures of 53.44 mmHg for MDT and 60.67 mmHg for MTR, and mean voluntary contraction pressures of 94.50 mmHg for MDT and 95.47 mmHg for MTR. There was no statistical difference between the groups. The shapes of the simple and enhanced pressure curves did not present any statistical difference, independent of the surgical technique used. CONCLUSION: The two surgical techniques were equivalent. MDT caused greater incidence of postoperative constipation that MTR did. AM and P were shown to be excellent tests for postoperative follow-up among these patients.
- ItemSomente MetadadadosEfeito do cloreto de benzalcôneo aplicado sobre o cólon de ratos(Universidade Federal de São Paulo (UNIFESP), 1998) Gerardi Filho, Vicente Antonio [UNIFESP]; Martins, José Luiz [UNIFESP]Estudou-se o efeito do cloreto de benzalcôneo a O,I por cento aplicado na superfície serosa do cólon sigmólde de ratos machos, Wistar, com 90 dias de vida. Utilizou-se 135 ratos subdivididos em 3 grupos de 45 ratos: grupo I aplicação de cloreto de benzalcôneo a O,I por cento diluído em álcool 70 por cento na superfície serosa do cólon sigmóide, por 30 minutos, por meio de esponja com extensão de I,Ocm; grupo 11 - aplicação de álcool a 70 por cento e grupo 111 - permanência de esponja embebedora das substâncias por 30 minutos. Cada grupo foi subdividido em 3 grupos de 15 ratos com eutanásia aos 7, 15 e 30 dias para retirada do cólon lesado e suas regiões proximal e distal. Cortes dessas regiões foram submetidos a estudo histológico pela técnica de hematoxilina e eosina e estudo imunohistoquímico pela técnica da avidina-biotina-peroxldase para a pesquisa de proteína S-100. Os resultados mostraram que os ratos do grupo I e 11 perderam peso nos primeiros 15 dias e aumentaram aos 30 dias. A circunferência do cólon foi maior nos primeiros 7 dias, para os grupos I e 11. A dissensão abdominal nos primeiros 7 e 15 dias foi mais acentuada nos grupos I e 11. Aderências intestinais foram observadas nos grupos I e 11 em todos os períodos de tempo. O grupo I apresentou maior quantidade de fezes amolecidas e constância de fezes na região peri-anal, principalmente aos 7 dias. Os grupos I e 11 apresentaram aos 7 dias tecido inflamatório agudo que gradativamente passa a tecido do tipo linfocitário aos 15 e 30 dias, e o tecido de granulação foi exuberante em todos os ratos dos grupos I e 11. Ocorreu uma maior destruição das camadas serosa e muscular do cólon no grupo 11 e maior destruição das camadas muscular, submucosa e mucosa no grupo 1. Em ambos os grupos ocorreram diminuição dos feixes neurais e células ganglionares dos plexos mloentérícos, sendo que o grupo 11 tem lesões mais intensas que o grupo 1.
- ItemSomente MetadadadosEletromanometria ano-retal: sua avaliação nos indivíduos normais e naqueles portadores de megacolo chagásico(Universidade Federal de São Paulo (UNIFESP), 1977) Matos, Delcio [UNIFESP]; Oliveira, Edison de [UNIFESP]